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    Invasive Fungal Infections in Children With Acute Myeloid Leukemia: A Single-center Experience Over 19 Years
    (Lippincott Williams and Wilkins, 2023) Avcu, G.; Karadas, N.; Goktepe, S.O.; Bal, Z.S.; Metin, D.Y.; Polat, S.H.; Aydinok, Y.
    Objective: Invasive fungal infections (IFIs) remain a significant cause of morbidity and mortality in children with acute myeloid leukemia (AML). This study aimed to evaluate the incidence, risk factors, etiology, and outcome of IFIs in children with AML and the effect of mold-active antifungal prophylaxis. Materials and Methods: We retrospectively reviewed pediatric patients treated for AML between January 2004 and December 2022. Proven, probable, or possible IFIs were defined using standardized definitions of the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) classification published at 2008. Results: A total of 298 febrile neutropenia episodes from 78 patients were evaluated. Proven, probable, and possible IFI rates were 3%, 2.6%, and 9.4%, respectively. Profound neutropenia was detected in 18 (58%) and prolonged neutropenia in 20 (64.5%) of the IFI episodes. Invasive aspergillosis accounted for the majority of IFI episodes; however, non-albicans Candida spp. were the most isolated pathogens in the proven group. Patients with relapsed AML were particularly at risk for the development of IFI (P=0.02). A significant decrease in IFI episodes was achieved with mold-active antifungal prophylaxis with voriconazole (P=0.01, odds ratio: 0.288, %95 CI:0.104-0.797). The overall mortality was 35.8%, and the IFI-attributable mortality rate was 25%. In the multivariate analysis, relapsed disease was the most significant risk factor associated with mortality (P=0.006, odds ratio:4.745; 95% CI: 1.573-14.316). Conclusion: Mold-active prophylaxis reduced the rate of IFIs in this cohort however IFI-related mortality was still high as 25% in pediatric AML patients. Relapsed AML was the most significant risk factor associated with mortality. © 2023 Lippincott Williams and Wilkins. All rights reserved.
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    Micafungin Use in Children: A Tertiary Referral Hospital Experience in the Treatment of Invasive Fungal Infections
    (AVES, 2023) Güner, Özenen, G.; Şahbudak, Bal, Z.; Özek, G.; Bilen, N.M.; Ümit, Z.; Terek, D.; Polat, S.H.
    Objective: Invasive fungal infections (IFIs) are a major cause of mortality and morbidity in hospitalized pediatric patients due to limited treatment options. Micafungin has been the most recently approved echinocandin for the treatment of IFIs in children; however, the data on efficacy and adverse events in children has been limited. This study aimed to evaluate the characteristics, treatment responses, and the incidence of adverse events of the micafungin treatment in children. Material and Methods: This retrospective study was designed to evaluate all patients under 18 years old who received micafungin for treatment between January 2017-December 2019. A standardized form was used to collect demographic characteristics, underlying medical conditions, diagnosis of fungal infections, laboratory findings, prognosis, and mortality (14-day mortality, 30-day mortality). Results: We evaluated 43 episodes of 39 patients who received mica-fungin for treatment. Median age of the patients who received mica-fungin for treatment was 2.3 (10 days-17 years and six months) years. Micafungin was used for definitive treatment in 18 (41.9%) patients, for empiric treatment in 15 (34.9%) patients, and for febrile neutrope-nia in 10 (23.3%) patients. Median duration of micafungin treatment was 14 (3-53) days. Treatment efficacy was found as 79.1% in clinical response and 81.3% in mycological response. The incidence of hepat-ic adverse events was 20.9% and renal adverse events 2.3% while using micafungin for treatment. In patients who received micafungin for treatment, 14-day and 30-day mortality rates were 7% and 9.3%, respec-tively. However, these deaths were not attributable to a fungal infection (two patients died due to heart failure, and two patients died due to respiratory failure). Conclusion: We demonstrated that micafungin might be a safe and effective antifungal agent for empiric therapy and definitive therapy. Further and more extensive prospective studies to evaluate the efficiency and safety of micafungin in children are needed. © 2023, AVES. All rights reserved.